Provider Demographics
NPI:1477612646
Name:CHOU, JAIMIE SOKHENG (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JAIMIE
Middle Name:SOKHENG
Last Name:CHOU
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:JAIMIE
Other - Middle Name:SOKHENG
Other - Last Name:PICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:1720 E 120TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3052
Mailing Address - Country:US
Mailing Address - Phone:310-668-3959
Mailing Address - Fax:310-223-0621
Practice Address - Street 1:1720 E 120TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3052
Practice Address - Country:US
Practice Address - Phone:310-668-4272
Practice Address - Fax:310-223-0621
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS220861041C0700X
CAPSY26593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2983DOtherMEDICARE GROUP
CAWSW22086AMedicare PIN